The highest court in Texas has rejected a historic challenge to the state’s anti-abortion laws from a group of 22 women – some of whom nearly died during pregnancy – demanding urgent clarity on whether emergency medical exceptions to abortion bans include life-threatening pregnancies.
On Friday, a unanimous Texas Supreme Court decided that the state law was broad enough.
Plaintiffs in Zurawski v Texas had urged the state to allow doctors to use their best medical judgment without fear of prosecution under the state’s severe anti-abortion laws, after providers denied them emergency abortion care during complicated pregnancies that put their health and lives at risk.
The women argued that providers would be too afraid to act, potentially facing decades in jail, tens of thousands of dollars in fines, and the loss of their medical license for violating Texas abortion bans.
Last year, after a court heard harrowing testimony from women who detailed their traumatic pregnancies and what they characterized as the state’s failure to care for them, a judge issued a temporary injunction that allowed doctors to make a “good faith judgment” on whether to provide emergency abortion care. The order was immediately appealed by the state’s Republican Attorney General Ken Paxton.
Texas Supreme Court justices then overturned the lower court’s ruling on Friday, claiming that it “departed from as written without constitutional justification.”
The court did clarify that exceptions can be made for life-threatening conditions like preterm premature rupture of membranes, known as PPROM, but the justices did not say when it could apply.
“A ‘life-threatening physical condition’ is not necessarily one actively injuring the patient; it is a condition that has the potential to kill the patient. The condition must arise from or be aggravated by the pregnancy, but death need not be imminent,” according to the Texas Supreme Court.
“Frankly this ruling feels like a gut punch,” according to lead plaintiff Amanda Zurawski, speaking to reporters on Friday. “Not just for pregnant Texans but doctors in our state.”
After she became pregnant in 2022, Zurawski dilated prematurely, and soon after her membranes ruptured, draining amniotic fluid and endangering the life of her expected child.
Doctors informed her there was nothing they could do under what was recently enacted state law, despite knowing with complete certainty that her daughter would die.
The condition led to life-threatening sepsis. Doctors ultimately induced labor. Her daughter, which she named Willow, was not alive when she delivered.
“This ruling is heartbreaking but it is not the end,” she said on Friday. “We will not be silenced… We are the faces of women across the country who are standing up to be heard.”
Samantha Casiano’s expected child was diagnosed with anencephaly, a fatal birth defect in which a baby is born without parts of a brain or skull. She was forced to give birth to a three-pound baby who died hours later.
“There’s more women just like us,” she said on Friday. “I hope that they hear us and make a change.”
The Supreme Court’s ruling does not mention Casiano or the lawsuit’s 20 other plaintiffs, except for Zurawski.
“The opinion erases the women … as though their pain and experiences don’t exist or matter,” according to Nancy Northup, president of the Center for Reproductive Rights, the legal group that represented the women.
Center for Reproductive Rights attorney Molly Duane added that “the court wrote our clients … entirely out of the decision.”
The ruling “utterly fails to provide the clarity doctor’s need to when they can provide abortion care to patients,” and “lays bare the consequences of the Supreme Court’s reversal of Roe v Wade” in 2022, according to Northup.
“This kind of suffering will keep happening in Texas every day,” she said.
Dr Austin Dennard, an obstetrician-gynecologist and a plaintiff in the case, was moved to tears on Friday.
“I’m actually surprised at how upset I am because I felt like Texas showed their cards with Kate,” said Dennard, referencing another Texas Supreme Court decision that blocked an emergency abortion for Kate Cox. She ultimately left the state to seek care.
“I love Texas, but it’s really hard to love Texas right now. And to know that people in a position of power feel that pregnant individuals should simply be vessels, and lose their rights entirely, and feel the type of pain we all felt, and to risk their lives the way we were all at risk, and to not have any rights whatsoever, is really hard to believe,” she added.
Texas is among more than a dozen states that have effectively outlawed abortion in most cases in the wake of the US Supreme Court’s ruling in Dobbs v Jackson Women’s Health Organization in June 2022.
The decision to overturn Roe v Wade has upended access to care for millions of Americans now forced to travel to states where abortion is protected, compounding the already-fractured and patchwork system for abortion care across the country.
